The overarching objective of the proposed research is to prevent alcohol-exposed pregnancies (AEP) and Fetal Alcohol Spectrum Disorders in American Indian communities. To accomplish this objective, the proposed research will utilize a Community-Based Participatory Research (CBPR) model to strengthen existing partnerships and utilize community participation in program development, implementation, and evaluation. Previous presentations, meetings, and discussions have highlighted the need for an AEP prevention project in the tribes included in this grant. Therefore, it is the goal of the proposed study to work with community partners using a CBPR collaborative research approach to support partnerships with tribes in the Northern Plains who have an interest in an AEP prevention program (SA 1). We will implement a community needs assessment to establish effective input from the community on the importance of AEP prevention efforts; what an AEP prevention project would ideally look like; and, if desired, how to best modify current AEP prevention projects to make appropriate for individual tribal communities (SA 2). Finally, based on results from the community needs assessment and input from Community Advisory Boards, AEP prevention pilot projects will be implemented in three large, hospital Indian Health Service (IMS) sites: Pine Ridge IHS Hospital, Sioux San IHS Hospital, and Rosebud Comprehensive IHS Hospital, all using CBPR principles (SA 3). There is great significance in this proposed study. First, it targets non-pregnant women from an extremely high-risk population, and it targets more than one risky behavior related to AEP. A focus on preventing FASD and AEP before a woman becomes pregnant would overcome a critical barrier in the field of FASD prevention. Utilizing CBPR methodology, a successful completion of the specific aims will alter the focus of FASD prevention with Al communities from more intervention efforts with pregnant women, where the pregnancy might already be alcohol-exposed, to a focus on prevention, where the ultimate goal is to prevent any and all pregnancies from having an alcohol-exposure. The goals of this proposed CBPR project will lead to an improvement both in scientific knowledge and clinical practice. The project is also innovative in that it promotes collaboration between tribes, utilizing experiences from one program to develop and expand on programs with other tribes and with larger clinical sites. RELEVANCE The short-term goal of this study is to, through CBPR methods; implement alcohol-exposed pregnancy (AEP) prevention programs with non-pregnant American Indian women, focusing on evaluating such programs for effectiveness in decreasing risky behaviors related to AEP. This leads to the long-term goal, which is to utilize CBPR principles to foster sustainable efforts to prevent AEP.